Provider Demographics
NPI:1790653251
Name:THE VILLAGE LACTATION
Entity type:Organization
Organization Name:THE VILLAGE LACTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAVENOR
Authorized Official - Suffix:
Authorized Official - Credentials:IBCLC
Authorized Official - Phone:443-266-6200
Mailing Address - Street 1:PO BOX 316
Mailing Address - Street 2:
Mailing Address - City:MARDELA SPRINGS
Mailing Address - State:MD
Mailing Address - Zip Code:21837-0316
Mailing Address - Country:US
Mailing Address - Phone:443-266-6200
Mailing Address - Fax:443-354-1853
Practice Address - Street 1:8077 BAPTIST CHURCH RD
Practice Address - Street 2:
Practice Address - City:MARDELA SPRINGS
Practice Address - State:MD
Practice Address - Zip Code:21837-2421
Practice Address - Country:US
Practice Address - Phone:443-266-6200
Practice Address - Fax:443-354-1853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-27
Last Update Date:2025-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Single Specialty